### Date : 2024-06-23 18:55 ### Topic : Pityriasis versicolor(Tinea Versicolor) #medicine #dermatology #infectology ---- ### Pityriasis Versicolor (어루러기) Overview **Pityriasis versicolor**, also known as **tinea versicolor** (어루러기), is a common superficial fungal infection of the skin caused by the yeast **Malassezia**. This condition affects the skin's pigmentation, leading to discolored patches that can be lighter or darker than the surrounding skin. ### Pathophysiology **Malassezia** species, which are part of the normal skin flora, can proliferate under certain conditions and lead to infection. The yeast produces azelaic acid, which inhibits melanocyte function, leading to the characteristic changes in skin pigmentation. ### Risk Factors - **Hot and Humid Weather:** The condition is more common in tropical and subtropical regions. - **Excessive Sweating:** Increased moisture on the skin promotes fungal growth. - **Oily Skin:** Malassezia thrives in oily environments. - **Weakened Immune System:** Individuals with compromised immune systems are more susceptible. - **Hormonal Changes:** Adolescents and young adults are more frequently affected, possibly due to hormonal influences on the skin's oil production. ### Symptoms - **Discolored Patches:** White, pink, red, or brown patches on the skin. The color may vary depending on skin tone and sun exposure. - **Scaling:** The patches often have a fine, dry, and scaly surface. - **Mild Itching:** Some individuals may experience itching, particularly when the weather is hot and humid. - **Common Locations:** The chest, back, neck, and upper arms are commonly affected. ### Diagnosis **Clinical Evaluation:** - **History and Physical Examination:** Assessment of the characteristic discolored patches and their distribution on the body. **Laboratory Tests:** - **KOH Preparation:** Skin scrapings examined under a microscope after being treated with potassium hydroxide (KOH) to reveal the yeast cells and hyphae. - **Wood's Lamp Examination:** Under ultraviolet light, affected areas may fluoresce a yellowish-green color, aiding in diagnosis. ### Example Case Study **Patient Profile:** - **Name:** Jee Hoon Ju - **Age:** 22 - **Occupation:** College Student **Medical History:** - **Symptoms:** Multiple light brown patches on the chest and back with mild scaling. The patches have been present for several months and are more noticeable after sun exposure. **Clinical Evaluation:** - **Physical Examination:** Numerous light brown, scaly patches on the chest and back, consistent with pityriasis versicolor. **Laboratory Tests:** - **KOH Preparation:** Positive for yeast cells and short hyphae. - **Diagnosis:** Based on clinical presentation and laboratory confirmation, Jee Hoon Ju is diagnosed with pityriasis versicolor. ### Management 1. **Topical Antifungal Treatments:** - **Selenium Sulfide Lotion or Shampoo:** Applied to the affected areas for 10-15 minutes before rinsing, typically used daily for one week. - **Ketoconazole Cream or Shampoo:** Applied to the affected areas, used daily for 1-2 weeks. - **Clotrimazole or Miconazole Cream:** Applied twice daily for 2-4 weeks. 2. **Oral Antifungal Treatments:** - **Itraconazole:** 200 mg daily for 5-7 days. - **Fluconazole:** 300 mg once weekly for 2-4 weeks. - **Note:** Oral treatments are generally reserved for extensive or recurrent cases. 3. **General Measures:** - **Hygiene:** Regular washing and drying of the affected areas to reduce moisture. - **Avoiding Excessive Heat and Humidity:** Keeping the skin cool and dry. - **Loose-Fitting Clothing:** Wearing breathable fabrics to reduce sweating. 4. **Preventive Treatment:** - **Intermittent Use of Antifungal Shampoos:** Using antifungal shampoos like selenium sulfide or ketoconazole once or twice a month to prevent recurrence. ### Prognosis - **Effective Treatment:** Most individuals respond well to antifungal treatments, with symptoms improving within a few weeks. - **Recurrence:** Pityriasis versicolor can recur, especially in hot and humid climates. Preventive measures and intermittent antifungal treatments can help reduce the frequency of recurrence. - **Pigment Changes:** It may take several months for the skin color to return to normal after treatment. ### Conclusion Pityriasis versicolor is a common superficial fungal infection that causes discolored patches on the skin. It is effectively treated with topical or oral antifungal medications. Maintaining good hygiene, reducing excessive sweating, and using preventive antifungal treatments can help manage and prevent recurrence. With proper care, most individuals with pityriasis versicolor can achieve complete resolution of symptoms.